21535 1198 IWPPELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date----------- / ------------------.. 1976 Permit No.------....246-3`5�-------------
The undersigned hereby a on P n s of the City of San Jose
for a permit to install plu i ien 1 arse side.
Exemption from requirement for tato o alifornia (or Contractor's License is hereby claimed
by undersigned: as owner ❑ statement {fled ❑ 2
'Undersigned attests that his State of California o }ors��Liy(/�j�/e
is in full fore e and effect and properly authorizes ih' a}io'� Y/
San Jose City Business License # -.14
.S
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS QO �x Lot No.
S-4VD 0
USE OF BUILDING
('Qn�✓�af 15vo a 1"D.. 9nr.
280.30(9'73) Signed ---- �--------....... .. - .......
1198 RUPPELL PLACE CENTA CENTRAL
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